AI-First Payer Enrollment and Billing Solution| Tech Mahindra

Unifying Payer Operations for Modern Health Plans

Tech Mahindra’s AI-First Enrollment and Billing Management capability manages end-to-end payer operations by unifying enrollment, premium billing, and revenue reconciliation. As a single operational backbone, the platform simplifies health management, ensures regulatory compliance, strengthens operational accuracy, and delivers seamless member experiences at scale across commercial and government programs.

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enrollment agents
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annual enrollments
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automation delivered across processes
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turnaround time compliance

Solution Highlights

  •  Group setup and maintenance, including employer changes benefit configuration, and renewals
  • Multi-channel enrollment processing through electronic data interchange (EDI), online enrollment capture (OEC), and paper-based applications
  • Broker engagements across onboarding, ongoing maintenance, recertification, and commission processing
  • Eligibility verification, Centers for Medicare & Medicaid Services (CMS) submissions, disenrollment, and audit support
  • Premium billing, reconciliation, dispute handling, subsidy management, and capitation-based payment handling
  • Compliance tracking, real-time reporting, governance frameworks, and business intelligence dashboards for faster decision-making
  • Support for state and federal program, including Medicare, Duals, Medicaid, and Exchange programs

Solution Benefits

  • Improve enrollment accuracy to over 99.7% through standardized workflows and automation
  • Reduce operational effort by up to 35% using AI, OCR, and RPA-powered intake and validation
  • Stay compliant with evolving CMS and state regulations through automated monitoring and audit-ready workflows
  • Scale operations up to 4x during AEP/OEP using proven seasonality management models

Impact in Action

Real-world examples of how we're helping healthcare organizations improve experiences, increase efficiency, and deliver measurable outcomes.

Benefits Administration Support

Transformed annual enrollment operations for a leading healthcare cost management and benefits administration provider through rolling volume forecasting and seasonal staffing. Reduced abandonment rates from 30% to 5%, increased agent productivity by 15%, and delivered 30% operational savings.

Government Elder Care

Modernized veteran support services for a U.S. government healthcare and Veteran services program with a scalable, HIPAA-compliant contact center. Improved provider data accuracy by 40%, accelerated turnaround times, and simplified navigation of complex VA systems.

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